6.3 Disorders of the Upper Gastrointestinal Tract Flashcards
1
Q
Aetiology/pathogenesis of peptic ulcers
A
- imbalance between regenerative and damaging forces of the gastric mucosa
- Usually brought on by H pylori infection, or NSAIDs that impair COX-1 (which otherwise replenishes mucosa)
- Pepsin and acid are required for pathogenesis
2
Q
Clinical features of peptic ulcers
A
- Epigastric pain (burning/aching), 1-3 hours after meals
- Anaemia
- Nausea/vomiting/haematemesis
- Malaena
- Bloating
3
Q
Investigations for suspected stomach ulcers
A
- Iron studies/CBC (?anaemia)
- H Pylori Breath Test
- H Pylori antibody blood test
- Endoscopy and biopsy
4
Q
Treatment of stomach ulcers
A
- Treat H pylori
- Discontinue NSAIDs
- PPIs to reduce acid secretion
5
Q
GORD pathophysiology
A
- Reduced action of Lower Oesophageal Sphincter
- If acid overwhelms the defensive capabilities of the stratified, non-keratinised squamous oesophageal epithelium, damage results
6
Q
What are some foods that can contribute to GORD? Lifestyle factors?
A
Foods:
- Caffeine
- Chocolate
- Pepperminet
- Alcohol
- Citrus/tomato (Vit C)
Lifestyle:
- Weight gain
- Smoking
- Eating, then lying down
7
Q
GORD symptoms
A
- Heartburn (sub-sternal burning discomfort)
- Regurgitation (bitter, acidic flux when lying down/bending over)
8
Q
GORD treatments
A
- Antacids
- PPIs/histamine antagonists
- Lifestyle changes
9
Q
Complications of GORD
A
- Stricture (narrowing 2° to attempted healing)
- Barrett’s oesophagus (metaplasia… uh oh)
10
Q
Pathogenesis of achalasia
A
- Failure of myenteric plexus
- Causes loss of relaxation of the lower oesophageal sphincter
(anti-GORD)
11
Q
Achalasia symptoms/signs
A
- Dysphagia
- Regurgitation
- Chest pain
- Cough
- Weight loss
12
Q
Achalasia Ix
A
- Manometry (measure muscle contraction)
- Barium swallow
- Endoscopy
13
Q
Achalasia management
A
- Dilation
- Botox (why does this work?)
14
Q
List some causes of dysphagia
A
- Neurological: stroke, dementia, ALS
- Muscular issues
- Obstruction
- Oesophageal: achalasia, cancer, motility disorders
- GORD: scarring of LOS
15
Q
What type of cancer is oesophageal carcinoma? What can it arise from, and what are some risk factors?
A
- Squamous cell adenocarcinoma
- Can progress from Barrett’s oesophagus
- Obesity, alcohol, smoking all predispose